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Friday, July 20, 2007

I was struck by a line in Linda's stem-cell post, below. It was a phrase I'd heard, in the same context, at a recent bioethics conference. It seems to me a rather odd thing for ethicists to be saying, and rather a bad idea to allow others to inject it unchallenged into the conversation about stem cells or any other ethical issue. Yet it encapsulates much of what has happened - and not to the good, I think - in bioethics in recent years.

[we may be] be only “a matter of months” from reaching the Holy Grail of biotechnology – producing an “ethical” human stem cell without using a human embryo

"Holy Grail"?

Leaving aside whether all of biotechnology is actually on a quest for the "Holy Grail", why exactly is that goal the creation of stem cells with a particular provenance (especially given that we're more or less swimming in stem cells ready for use already), and what about that makes those cells themselves "ethical"?

The issue, of course, is the controversy created over stem cells by those who view the human embryo as having moral standing equal to or greater than that of full human persons or the goals or projects that human persons may have. That vocal minority has succeeded in establishing its views and objections as practical barriers to almost all research carried out on human embryos, and to the harvesting of stem cells from such embryos. Given that the compromise position on that issue imposed by the Bush administration has proven increasingly unworkable, attempts have been made to find ways to move science forward in spite of such barriers. Some have sought alternate sources of funding to evade the federal ban, while others tout adult stem cells or other technological work-arounds as ways of conducting the research without using embryonic stem cells. From that latter perspective, the recent news of, supposedly, totipotent cells derived from pluripotent "adult" stem cells in mice was a welcome step forward. The thinking is that this may be a pathway to producing embryonic stem-cell equivalents without harvesting cells directly from embryos - thus answering objections to the use of the embryo.

It is understandable that those who have such objections would be interested in the recent report. But I still find it strange than anyone else is (for other-than-scientific reasons, at least), still less accepts it uncritically as some sort of ethical milestone.

What I think has happened is that the pro-science and pro-personhood communities have allowed themselves to be stampeded by religious activists, who have successfully imposed their particular beliefs as the perspectival framework on the stem-cell "controversy". That controversy itself was created out of whole cloth by those activists. That is, there is controversy over stem-cell research only in the sense that a specific part of a specific segment of the right-wing religious/political spectrum is offended by this research and have used their influence in the Republican party to interfere with it. It is an active controversy only because that minority is allowed to exercise its influence in this way. It is an active moral controvery - as opposed to being a straightforward exercise of power politics - only because the ethics and scientific communities, who are virtually unanimous in seeing no major ethical barriers to the work, have allowed themselves to be inveigled into a pretended moral argument actually fought on political grounds, where they cannot prevail but where their participation lends credibility to the moral claims propounded by the right-wing activists.

As a political strategy, this has paid huge dividends to the religious right. In adopting sectarian religious framing for an otherwise uncontroversial moral question - accepting a distinction between "ethical" and "unethical" stem cells, or that the development of non-embryonic totipotent cells is a necessary goal of stem-cell therapy research - researchers and ethicists have ceded to religious activists, as moral principle, the idiosyncratic beliefs that bring those activists to the struggle in the first place, and without which there would be no "controversy". Though virtually no one who is not ideologically committed to moral status for embryos on religious grounds regards this matter as even a live issue, they have in many cases implicitly ratified the manufactured moral objections of their opponents by accepting the challenge of solving problems whose moral significance is otherwise far from demonstrated. The matter of "ethical" stem cells thus functions for the religious right, in the research arena, the way creationism does in the educational sphere: the importance of their suggested solution to the problem is not that it fills a need in and of itself, but that seeking and accepting that solution implicitly concedes the truth of the beliefs that make it necessary. The difference is that, while the religious right's "equal time" demand was rejected by the courts in the case of creationism, their encouragement of the expenditure of time and resources on a search for other cells that might perform the functions of the cells already available has been adopted by the research community (with some strong-arming by the Executive Branch) as a legitimate goal. This not only diverts, to some degree, resources from research on existing totipotent cell lines, but it implicitly ratifies the assertion that research on embryonic cell lines is inherently questionable - again, a position that enjoys almost no support on grounds other than religious dogma. The implications for other questions involving embryos and fetuses are obvious, and an acknowledged part of the religious-right's strategy in these matters. I would think some kind of critical test of this putative "controversy" would be in order before so much ground would be given up so readily.

Retroverted adult stem cells are far from a "holy grail" in scientific terms. Even assuming that totipotency can be achieved by some manipulation of the cell's genes, doing so adds an extremely complex additional process to the further manipulation of those cells for therapeutic purposes. The use of totipotent cells for any therapeutic purpose is still in its earliest stages, and will, even when perfected, require extensive genetic invasions of the cellular development process. Each such manipulation raises the possibility of mishap, and the risk to the patient, even if beginning with normal embryonic stem cells. Partially-differentiated adult stem cells, manipulated first backwards and then forwards along a different developmental pathway, will always carry inherently greater risks simply because more has been done to them along the way, and there is thus more to go wrong. Besides that, insisting that the scientific community solve one immensely complex problem - how to force differentiated cells to alter themselves in ways they never do in nature, and to undo developmental processes that have already begun, to recover capacities that have already been lost - before even beginning to solve the already-daunting problem of guiding them along specific (but otherwise normal) developmental pathways, necessarily sets back the development of whatever cures may be possible by however long it requires to do that currently-unimaginable preliminary work. Other suggested - but so far almost entirely untested - sources of "ethical stem cells", such as William Hurlbut's proposed "Altered Nuclear Transfer" process, are even less scientifically grounded and require even more drastic genetic manipulations of the cell prior to implantation in a human body for therapeutic purposes. Putting promising stem cell work on hold, to go off on a tangential chase for a process to create, from differentiated cell lines, retroverted adult stem cells to perform the functions of the stem cells that we already have available, is a massive displacement of scientific effort, focus, and time. But that - all of the above - is what the "ethical stem cell" advocates would have us do.

That would seem to require some considerably compelling justification. But the only justification that is even offered is that these hypothetical retroverted adult stem cells are "ethical", while actual totipotent stem cells are not. The reason for that claim, again, is that the latter are derived from human embryos, to which some (not all) among the religious right object. Absent this objection - absent only the assertion that there is no "ethical" way to conduct research on stem cells derived from human embryos - there is no "controversy" over the issue at all, and there is no reason at all for these alternative lines of research. (NB: Some forms of this research - including the effort to control the differentiation pathway both forwards and backwards - are inherently scientifically valuable and should go forward. But that is incidental to their implications for so-called "ethical stem cells".) To emphasize that: the search for "ethical" stem cells has no importance whatsoever, other than the fact that it responds to objections raised by a certain segment of the religious right and grounded on their religous beliefs. There is no need for them otherwise, and they are less desirable therapeutically than the already-available alternative of actual embryonic stem cells. Such lines of research, and the diversion of time and resources they represent, have no point unless that religious objection is demonstrated to be a compelling moral claim. But the question of the use of embryos can be and has been debated extensively, with, again, an almost-unanimous consensus among the community of ethicists and widespread support within the general public.

So, why has the research community adopted, even implicitly, as its "Holy Grail", the almost literal "Holy Grail" of the religious community? How is it that the ethics community accommodates such manipulative, distracting, and dubious rhetoric without demur? I think this language, in the context of the stem-cell controversy, and in fact the existence of that "controversy", expose a failure to interrogate the conceptual and rhetorical framing of the issue assumed, and brought into the ongoing discourse, by those who have made it their business to take an obstructive stance toward this work. In acknowledging, even implicitly, that it is important to find "ethical stem cells" to replace the "unethical stem cells" currently under study, an opportunity is lost to ask on what grounds such concepts have entered the discussion to begin with, and how it is possible to apply the evaluative term "ethical" to biological entities as such, let alone single cells. But it may not be too late,yet, to abandon the quest for the Holy Grail.

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